Barnaby R Scholefield1, Kevin P Morris2, Heather P Duncan2, Gavin D Perkins3, Jessica Gosney2, Richard Skone2, Victoria Sanders2, Fang Gao4. 1. Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: Barney.scholefield@bch.nhs.uk. 2. Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK. 3. Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Academic Department of Anesthesia, Critical Care and Resuscitation, Heart of England NHS Foundation Trust, B9 5SS, UK. 4. School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, UK; Academic Department of Anesthesia, Critical Care and Resuscitation, Heart of England NHS Foundation Trust, B9 5SS, UK; Department of Anaesthesiology, The Second Affiliated Hospital & Yuying Children Hospital of Wenzhou Medical University, Wenzhou, China.
Abstract
BACKGROUND: It is unknown whether targeted temperature management (TTM) improves survival after pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the evolution, safety and efficacy of TTM (32-34 °C) compared to standard temperature management (STM) (<38 °C). METHODS: Retrospective, single center cohort study. Patients aged >one day up to 16 years, admitted to a UK Paediatric Intensive Care Unit (PICU) after OHCA (January 2004-December 2010). Primary outcome was survival to hospital discharge; efficacy and safety outcomes included: application of TTM, physiological, hematological and biochemical side effects. RESULTS: Seventy-three patients were included. Thirty-eight patients (52%) received TTM (32-34 °C). Prior to ILCOR guidance adoption in January 2007, TTM was used infrequently (4/25; 16%). Following adoption, TTM (32-34 °C) use increased significantly (34/48; 71% Chi(2); p < 0.0001). TTM (32-34 °C) and STM (<38 °C) groups were similar at baseline. TTM (32-34 °C) was associated with bradycardia and hypotension compared to STM (<38 °C). TTM (32-34 °C) reduced episodes of hyperthermia (>38 °C) in the 1st 24h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, and all patients (n = 11) experiencing temperature <32 °C died. The study was underpowered to determine a difference in hospital survival (34% (TTM (32-34 °C)) versus 23% (STM (<38 °C)); p = 0.284). However, the TTM (32-34 °C) group had a significantly longer PICU length of stay. CONCLUSIONS: TTM (32-34 °C) was feasible but associated with bradycardia, hypotension, and increased length of stay in PICU. Temperature <32 °C had a universally grave prognosis. Larger studies are required to assess effect on survival.
BACKGROUND: It is unknown whether targeted temperature management (TTM) improves survival after pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the evolution, safety and efficacy of TTM (32-34 °C) compared to standard temperature management (STM) (<38 °C). METHODS: Retrospective, single center cohort study. Patients aged >one day up to 16 years, admitted to a UK Paediatric Intensive Care Unit (PICU) after OHCA (January 2004-December 2010). Primary outcome was survival to hospital discharge; efficacy and safety outcomes included: application of TTM, physiological, hematological and biochemical side effects. RESULTS: Seventy-three patients were included. Thirty-eight patients (52%) received TTM (32-34 °C). Prior to ILCOR guidance adoption in January 2007, TTM was used infrequently (4/25; 16%). Following adoption, TTM (32-34 °C) use increased significantly (34/48; 71% Chi(2); p < 0.0001). TTM (32-34 °C) and STM (<38 °C) groups were similar at baseline. TTM (32-34 °C) was associated with bradycardia and hypotension compared to STM (<38 °C). TTM (32-34 °C) reduced episodes of hyperthermia (>38 °C) in the 1st 24h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, and all patients (n = 11) experiencing temperature <32 °C died. The study was underpowered to determine a difference in hospital survival (34% (TTM (32-34 °C)) versus 23% (STM (<38 °C)); p = 0.284). However, the TTM (32-34 °C) group had a significantly longer PICU length of stay. CONCLUSIONS: TTM (32-34 °C) was feasible but associated with bradycardia, hypotension, and increased length of stay in PICU. Temperature <32 °C had a universally grave prognosis. Larger studies are required to assess effect on survival.
Authors: Stephen Pfeiffer; Matthew Zackoff; Katelyn Bramble; Lindsey Jacobs; Kristen Ruehlmann; Erika L Stalets; Ken Tegtmeyer; Maya Dewan Journal: Pediatr Qual Saf Date: 2021-03-10
Authors: Do Kyun Kim; Won Kyoung Jhang; Ji Yun Ahn; Ji Sook Lee; Yoon Hee Kim; Bongjin Lee; Gi Beom Kim; Jin-Tae Kim; June Huh; June Dong Park; Sung Phil Chung; Sung Oh Hwang Journal: Clin Exp Emerg Med Date: 2016-07-05
Authors: Wojciech Wieczorek; Jarosław Meyer-Szary; Milosz J Jaguszewski; Krzysztof J Filipiak; Maciej Cyran; Jacek Smereka; Aleksandra Gasecka; Kurt Ruetzler; Lukasz Szarpak Journal: J Clin Med Date: 2021-03-30 Impact factor: 4.241